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INDIAN INSTITUTE OF MANAGEMENT TIRUCHIRAPPALLI

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FELLOW PROGRAMME 2017

Area of Specialization - (Please tick (√) any one of the following boxes.

(If you are applying to one more area, please use a separate application form)

FELLOW PROGRAMME IN MANAGEMENT with specialization in:

Economics and Public Policy Finance and Accounting Marketing Management Information System and Information Technology Strategic Management Organizational Behavior and Human Resources Operations Management and Quantitative Techniques

Personal Details Name

Father’s/Guardian’s Name

(In block letters, as in school leaving certificate)

Affix Your Recent Passport Size Photo Here

Gender: Male Female

Permanent Address (in Block Letters) PIN

Mailing Address (in Block Letters) PIN E-Mail Address Telephone No. Mobile

Date of Birth Nationality Marital Status

Category to which you belong

[Please tick (√) and enclose an attested copy of relevant certificate]

SC ST NC-OBC Others

Single Married


2

Are you disabled? (As defined in the Persons with Disability Act, 1995; enclose certificate

if applicable):

Yes No

State of Domicile:

Details of Admission test(s) that you have taken:

Please tick the admission test(s) that you have taken:

CAT GMAT GATE GRE UGC- JRF

Test Registration No. (available from your admit card upon successful registration)

CAT Percentile

b. If you are applying through GMAT/GATE/GRE/UGC-JRF please fill in the name(s) of

the test(s) taken by you in the first column and then various scorers/percentiles-

Verbal/Quantitative etc. as applicable in the subject column.

Test/Exam

Details of remittance of Application fee:

NEFT Transaction No. Date of Remittance Name and Area applied - mentioned in the

remarks column of the NEFT payment

Note: Application fee of Rs.500/- (No fee for SC / ST / DAP candidates. Such candidates are required to attach a

copy of the relevant caste certificate with their application.) to be remitted through NEFT SB A/c No. 32170808935;

IFSC Code: SBIN0001617 of SBI, NIT Campus before 20 January 2017). Kindly attached a copy of the

screen shot of the NEFT payment made. If applying to more than one area, application fee needs to

be paid separately for each area application.


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Details of Academic Record from High School onwards (in reverse chronological order)1

Name of the

Degree/

Certificate/

Diploma

Institution

Period Subjects taken

Major & Minor

Class/Grade/

Divn../ % of marks

From

To

Details of Work Experience (You can use additional sheets, if required)

Name & Address of

Employer

Designation Date Remuneration

(per month) Nature of

Work From To

List of honours, awards, and distinctions that you have received:

1 In case the space in this form is not sufficient for any section, please attach separate sheets and reference the

additional sheets in the form


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Briefly (but clearly) state your research interests that lead you to apply to the Fellow Programme

in Management at IIM Tiruchirappalli

Why do you think you should be selected, given your career goals, personal attributes/

achievements?

In case you have applied to two areas of specialization, please give the reasons for doing so and

also justify the other area applied:


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Please state any other information that you would like to provide in support of your candidature

An application in each area of specialization requires two letters of recommendation in sealed envelopes

signed by the recommenders across the seal. If you are applying to 2 areas, you need to enclose

separate recommendation letters to both areas even if the same recommenders are providing the letter

for both areas. Recommenders should be persons who are in a position to comment on your

candidature. At least one recommender should be a faculty member of a University/ College/Institute of

advanced learning. An application will be treated as incomplete without the two recommendation letters.

Instructions for submitting these letters are contained in the enclosed recommendation forms. Blank form of

recommendation is enclosed.

Name and addresses of the recommenders:

Name: Name:

Address: Address:

List the documents enclosed with this application:

1. 5.

2. 6.

3. 7.

4. 8.

I certify that the information given by me in this application is correct.

Date:

Place: Signature of Applicant


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FELLOW PROGRAMME 2017

Letter of Recommendation

To be completed by the Applicant

Name of Applicant: ______________________________________________

Area Applied for (Please tick only one area for which this letter is applicable)

Economics and Public Policy Finance and Accounting Strategic Management Management Information System and Information Technology Marketing Organizational Behavior and Human Resources

Operations Management and Quantitative Techniques

Date……………….. Signature of Applicant………………………………..

To be completed by the person providing Reference

Thank you for agreeing to fill out this recommendation letter.

The above candidate has applied to the Fellow Programme (equivalent to a doctoral programme) of IIM

Tiruchirappalli. After filling out the recommendation form, please place it in an envelope, seal the

envelope, and sign across the seal. Hand over the sealed envelope to the applicant, and instruct him/her to

submit your sealed envelope along with his/her completed application form to Admissions Office, Indian

Institute of Management Tiruchirappalli, NIT Campus, Tanjore Road, Tiruchirappalli - 620 015.

Details about the applicant

I know the applicant for………………… years.

He / She has been (tick the appropriate answer)

Student in my course(s) A personal friend or acquaintance

My advisee Others (Please Specify)


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I would rank him/her as indicated below (please tick as appropriate)

Category Excellent Very good Good Fair Poor No basis for

judgment

Academic Strength

Motivation

Teaching

Potential

Research

Potential

Writing

ability

Speaking ability

Overall Rating

Strengths of the candidate:

Weaknesses of the candidate:


3

Comments on the candidate’s suitability to pursue a doctoral level programme

(please use additional sheets if necessary)

Details of the person providing reference

Name Designation_

Signature Date_

Affiliation

Address

Phone Number(s) Email

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